Why Hospitals Are Cold, and Doctors Don’t Cry (in Public)

Recently I almost cried in front of a patient and her family. The scene was a basic one: a dying woman, her concerned husband and her startled, kind-hearted sons. Standing at the bedside, we talked awhile about what a long haul it had been, how hard she had fought.

Their eyes misted over, and I, too, felt a sob rise. But rather than weep then and there, I quickly shook their hands and left.

And then I went to the stairwell, where I had myself a little cry. Nothing dramatic, no howling or barking, just a brief shiver of sadness, a tear, and I was done. The hospital stairwell, once the provenance of smokers, now plays host to those who need to sneak away when the going gets tough.

Given the intensity and high-voltage anxiety of serious illness, public crying in hospitals — by patients or family or staff — is less common than one might expect. Sure, it goes on more frequently than, say, at a department store or a restaurant. But more often, people remain buttoned up, dry-eyed, determined to maintain composure.

This stiff upper lip strategy often is miscast as further proof of the chilliness of the hospital experience: you know, cold doctors and colder hallways. And surely, placed against hospitals’ behavior across the decades — their institutionalized rudeness, the titanic narcissism and the casual disregard of patients, families and everyone in between — a sob-free doctor can look bad.

But often overlooked in the cataloging of hospitals’ crimes against humanity is this uncomfortable truth: the cold, cold heart of hospitals has somehow created something useful, even crucial to society. The medical center is responsible now for the hardest job in the world because this is where people end up when the facts can no longer be hidden, when there is no more escape. A hospital’s modern responsibility is to bluntly deliver to the dying the unhappy news that this is it, the jig is up. Nowhere else can such impossible information change hands so routinely.

To offset this bleakness, however, the unrelenting hurry of approaching death is pulverized into a thousand pain-free little maneuvers that make up the daily routine, something only a full-service health care institution can do.

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Monitoring the potassium, adjusting the antibiotics, getting the latest scan result — this is a full-time job, enough to keep a patient and family completely distracted from the awful truth. The welter of information, so much of it useless, is the accidental genius of our current health care system.

And it works — witness the difficulty so many face with dying at home. Almost everyone confronted with the choice expresses the wish to die among familiar surroundings. All the necessary pieces — visiting professional care, a hospital bed, an I.V. pole, the works — can be gathered with relative ease.

Yet frequently, it gets too, well, emotional. Sitting in a den or dining room awaiting death is too intimate, too personal, the free-fall toward the end too breathtaking.

So patient and family return to the bustle and insensitive self-importance of the hospital. And they get the full monty: the reassuring whir and hurry of blood samples run at all hours, portable X-rays taken in the next bed, scratchy announcements over the loudspeaker.

And the never-ending supply of dry-eyed doctors run amok, full of opinions and chatter and contradictory advice. A tear (much less a sob) from one would shatter the entire unnatural protocol.

This odd arrangement did not occur by grand design. But somehow two of today’s towering certainties — death and corporate insensitivity — have found each other and have merged their mutual awkwardness into an almost functional whole.

We now give our loved ones the perfect send-off from life in the information age: a shower of facts delivered crisply and without drama by the unruffled doctor in the hall of that ice palace, the American hospital.